Last week, Politico had an item noting that Democrats are "accusing" Donald Trump of sabotaging the Affordable Care Act. There wasn't anything especially wrong with the article, except for the fact that it presented the sabotage question as a matter of partisan debate: Dems are making an accusation, while Republicans deny it.
The trouble is, the truth is unambiguous. The Trump administration's sabotage campaign is both real and lacking in subtlety.
Vox had a good piece yesterday summarizing the most obvious ways the White House is deliberately undermining the nation's health care system, and the list wasn't exactly short. From shrinking the open-enrollment period to threatening to cut off cost-sharing-reduction payments to insurers, curtailing ad campaigns to slashing in-person sign-up programs, Trump World seems determined not to help Americans get the health care coverage they're entitled to under the law.
The real-world effects of this are already quite real, with consumers having to pay more -- what congressional Democrats refer to as a "Trump Tax" -- as a direct consequence of Trump's actions.
This morning, the White House's campaign went quite a bit further. The Washington Post reported:
President Trump signed an executive order Thursday morning intended to allow small businesses and potentially individuals to buy a long-disputed type of health insurance that skirts state regulations and Affordable Care Act protections.The White House and allies portray the president's move to expand access to "association health plans" as wielding administrative powers to accomplish what congressional Republicans have failed to achieve: tearing down the law's insurance marketplaces and letting some Americans buy skimpier coverage at lower prices.
OK, let's unpack this a bit, because the consequences are likely to affect a lot of people, and not in a good way.
Under the current law, the Affordable Care Act establishes a series of standards private insurers have to meet in order to qualify for exchange marketplaces. For the right, this is a problem: by making coverage better, the law also makes coverage more expensive.
And so Trump has signed an executive order to effectively do the opposite: expand access to worse coverage -- what's often referred to as "skimpy" plans -- at a lower cost. As the New York Times' report explained, the administration is moving forward with plans to "develop rules that would expand access to less expensive, less comprehensive insurance, including policies that could be sold by trade associations to their members and short-term medical coverage that could be offered by commercial insurers to individuals and families."
This insurance will be exempt from the ACA's safeguards, and not surprisingly, the plans will offer those who buy the coverage far less. Indeed, these plans won't even have guaranteed essential health benefits or protections for those with pre-existing conditions -- which happen to be the most popular parts of "Obamacare."
At first blush, the idea may not sound like much of a problem. If some consumers want to buy bad and cheap insurance, that'll just affect them, right? Wrong. Many in the industry believe younger and healthier people will gravitate to these low-cost, low-coverage plans because the insurance is cheap and these folks aren't as worried about their health,
But then the ripple effect kicks in: older and less-healthy consumers will end up having to pay more once younger and healthier consumers have their own cheaper/worse alternative. The result means higher costs for those who need care most and vastly less market stability. In other words, Trump is trying to create a problem that the ACA was designed to avoid.
There are some unanswered questions here, which is why you may have noticed I haven't mentioned any specific numbers. Trump's new executive order doesn't immediately make new policy, but rather, instructs various federal agencies to begin writing new rules to shape a policy. Until we know the details of those as-yet-unwritten rules, we can't say with certainty how widespread the impact of this change will be. What's more, it's a safe bet there will be more than a few lawsuits once the administration's new approach is ready to go.
That said, it's not too early to describe this as Trump's most significant move to date to sabotage the American health care system -- for reasons he hasn't fully explained and almost certainly doesn't understand.
Postscript: The politics of health care isn't nearly as significant as the policy implications, but as long as we're on the subject, today helps mark the shift from "Obamacare" to "Trumpcare." If, as expected, Trump's policies leave millions of Americans worse off -- or in a worst-case scenario, actually crashes the individual market -- it'll be too late for Republicans to say, "Obama did it."
Trump is taking ownership of the system he's making worse. The results will be on him and no one else.